Literature Collection

Children with chronic diseases, including pulmonary hypertension (PH), have an increased risk of anxiety and depression (AD), impacting mental health (MH), and quality of life (QoL). We sought to characterize the prevalence of AD in pediatric PH and identify associated factors. We developed a prospective cross-sectional study with 10 Pediatric Pulmonary Hypertension Network (PPHNet) centers. Eligible subjects aged 12-21, diagnosed with PH, and English or Spanish speaking, completed validated AD screening questionnaires during routine outpatient clinic visits. Caregivers provided socioeconomic status (SES) data and MH history via survey. Patient demographics and clinical characteristics were analyzed using standard descriptive statistics. Eighty-eight patients were enrolled (female = 54, 61%). Forty-six (51.7%) identified at least mild symptoms of AD. Females were more likely to report AD than males (OR 2.67, 95% CI 1.11-6.61, p = 0.030). There were no significant associations between AD and PH severity, MH history, family dynamics, SES status, race, or ethnicity. Twenty-seven of those patients (58.7%) received MH education/counseling by MH professionals; ten (21.7%) were referred to MH providers, and nine patients (19.6%) were assessed for suicide safety. Adolescents with PH have a high prevalence of AD. Female patients had increased AD compared to male patients; no other predictors were linked to the prevalence of AD. Routine AD screening should be integrated into outpatient PH clinic visits with a focus on psychosocial support for young females diagnosed with PH.

OBJECTIVE: To explore the relationships among anxiety, depression, and headache-related disability in a pediatric clinic-based retrospective cross-sectional study. BACKGROUND: Anxiety and depression are commonly considered comorbidities of headache disorders and are frequently seen in children and adolescents. These conditions can contribute to disability and may have a cumulative impact. In this study, we tested whether self-reported anxiety and/or depression in youth were associated with headache-related disability. METHODS: This was a retrospective cross-sectional study of children ages 6-17 years old who completed a headache intake questionnaire at the time of a new outpatient neurology visit. Those who reported on behavioral health symptoms, involvement of a behavioral health provider (i.e., yes/no), and the PedMIDAS (a validated metric of headache-related disability) were included. The relationship between anxiety and/or depression and headache-related disability was examined. RESULTS: Of the 12,660 questionnaires queried, 9118 met criteria for inclusion. Respondents were 64.0% female and had a median age of 13.5 years (interquartile range [IQR] 10.3, 15.7). Compared to patients without self-reported anxiety/depression, patients with anxiety and depression reported higher headache-related disability (M = 17.0, [IQR 6.0, 41.0]) even after accounting for covariates (estimated difference = 6.0, 95% confidence interval [CI: 4.4-7.5]). For participants with anxiety and/or depression, having a behavioral health provider was associated with greater headache-related disability (estimated difference = 7.0; 95% CI 4.6-9.3). CONCLUSIONS: Patients with self-reported anxiety and/or depression reported higher headache-related disability. Having a behavioral health provider was associated with greater headache-related disability, indicating the complexity and high level of need for this population. Further research is needed to understand the directionality of these results; however, patients with headache as well as depression and or anxiety are a vulnerable group who may benefit from an integrated care model.

INTRODUCTION: Quantitative global or regional brain imaging measurements, known as imaging-specific or -derived phenotypes (IDPs), are commonly used in genotype-phenotype association studies to explore the genomic architecture of the brain and how it may be affected by neurological diseases (e.g., Alzheimer's disease), mental health (e.g., depression), and neurodevelopmental disorders (e.g., attention-deficit hyperactivity disorder [ADHD]). For this purpose, medical images have been used as IDPs using a voxel-wise or global approach via principal component analysis. However, these methods have limitations related to multiple testing or the inability to isolate high variation regions, respectively. METHODS: To address these limitations, this study investigates a localized, principal component analysis-like approach for dimensionality reduction of cross-sectional T1-weighted MRI datasets utilizing diffeomorphic morphometry. This approach can reduce the dimensionality of images while preserving spatial information and enables the inclusion of spatial locality in the analysis. In doing so, this method can be used to explore morphometric brain changes across specific components and spatial scales of interest and to identify associations with genome regions in a multivariate genome-wide association study. For a first clinical feasibility study, this method was applied to data from the Adolescent Brain Cognitive Development (ABCD) study, including adolescents with ADHD (n = 1,359), obsessive-compulsive disorder (n = 1,752), and depression (n = 1,766). RESULTS: Meaningful associations of specific morphometric features with genome regions were identified with the data and corresponded to previous found brain regions in the respective mental health and neurodevelopmental disorder cohorts. DISCUSSION: In summary, the localized, principal component analysis-like approach can reduce the dimensionality of medical images while still being able to identify meaningful local brain region alterations that are associated with genomic markers across multiple scales. The proposed method can be applied to various image types and can be easily integrated in many genotype-phenotype association study setups.

OBJECTIVE: Integrating pediatric obesity care into primary care remains challenging, especially in underserved areas. To address this, the REACH-KIDS (Reverse Consult Care Model for the Comprehensive Treatment of Pediatric Obesity in Primary Care) program, which aims to empower primary care clinician through education and resources was developed. This study describes the design and early evaluation of a quality improvement initiative aimed at building PCP capacity in pediatric obesity care using a collaborative care model. METHODS: The REACH-KIDS model was implemented across two sites, involving didactic mini-series sessions designed to educate primary care clinicians on obesity care. The program's feasibility was evaluated by tracking attendance, engagement, satisfaction, and knowledge gained. Between November 2023 and May 2024, two mini-series were conducted across the sites, and feedback was gathered to assess shifts in clinical practice, particularly in anti-obesity medication use. RESULTS: At Site one, 68, 67, and 67 attendees participated in September, October, and November 2023 sessions, respectively. At Site two, 42, 45, and 52 attendees participated in March, April, and May 2024. Most attendees (75%) reported a shift in clinical practice regarding obesity pharmacotherapy after attending the mini-series. Satisfaction with the sessions was high, and knowledge assessments significantly improved participants' understanding of obesity treatment options. Notably, participants reported increased confidence in prescribing anti-obesity medications, indicating a positive clinical impact of the educational intervention. CONCLUSIONS: The REACH-KIDS model demonstrated feasibility and effectiveness in improving primary care clinicians' knowledge of comprehensive obesity care. This quality improvement initiative highlights the potential of education and collaboration to enhance obesity care in primary care settings. Future studies should focus on expanding this model and assessing its impact on clinical outcomes in underserved populations. Limitations include the restricted geographic scope and reliance on self-reported changes in clinical practice; future work will require objective measures of patient outcomes and broader implementation.